TY - JOUR
T1 - Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter
T2 - A nation-wide Danish cohort study
AU - Giehm-Reese, Mikkel
AU - Johansen, Martin Nygård
AU - Kronborg, Mads Brix
AU - Jensen, Henrik Kjærulf
AU - Gerdes, Christian
AU - Kristensen, Jens
AU - Johannessen, Arne
AU - Jacobsen, Peter Karl
AU - Djurhuus, Mogens Stig
AU - Hansen, Peter Steen
AU - Riahi, Sam
AU - Nielsen, Jens Cosedis
N1 - Copyright © 2021 Elsevier B.V. All rights reserved.
PY - 2021/6/15
Y1 - 2021/6/15
N2 - INTRODUCTION: Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation.PURPOSE: To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.METHODS: We identified patients undergoing first-time CTIA during the period 2010-2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.RESULTS: We identified 2409 consecutive patients. Median age was 66 (IQR 58-72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21).CONCLUSION: In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
AB - INTRODUCTION: Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation.PURPOSE: To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL.METHODS: We identified patients undergoing first-time CTIA during the period 2010-2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018.RESULTS: We identified 2409 consecutive patients. Median age was 66 (IQR 58-72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21).CONCLUSION: In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
KW - Administration, Oral
KW - Aged
KW - Anticoagulants/adverse effects
KW - Atrial Fibrillation/diagnosis
KW - Atrial Flutter/diagnosis
KW - Catheter Ablation/adverse effects
KW - Cohort Studies
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Male
KW - Risk Assessment
KW - Risk Factors
KW - Stroke/diagnosis
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85102292487&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2021.02.057
DO - 10.1016/j.ijcard.2021.02.057
M3 - Journal article
C2 - 33647366
VL - 333
SP - 110
EP - 116
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -